Infertility in a woman under 35 is defined as trying to get pregnant for one year, but not being successful. In a woman over 35, it’s defined as six months of trying. So, if a woman is under 35, we usually say wait a year and if you’re not pregnant, let’s get testing done. The reason for the discrepancy between six months and one year is that the single biggest factor that affects fertility in a woman is her age. In the older age categories – past age 35 – the chances of conception drop much more rapidly than in the younger age categories. Past 35, if it hasn’t happened in six months, at least let’s get the testing done and figure out if there’s a problem. If there’s no problem, you have the option of trying on your own for longer. If there is a problem, let’s fix it so we’re not wasting time.
When should I seek treatment for infertility?So, when should you seek care? At one year, six months or whenever you’re concerned. If you feel like your cycles are completely erratic or you know you’re not ovulating, of course you don’t have to wait that whole year to come in and be seen. Seek treatment if you know that:
- You’ve had an infection in the past that might have affected your tubes
- You have endometriosis
- Your husband has sperm issues
- Your husband has had a bad testicular injury in the past.
How do you test for infertility?
Basic testing for infertility involves checking the woman’s egg quantity, checking her basic hormones, checking her anatomy and, for the husband, checking his sperm by doing a semen analysis.
In the initial visit, we always take a full history for the patient and her husband, see if there’re any lifestyle factors or medical conditions that might be affecting fertility.
We always do a sonogram in the first visit to take a look at the woman’s anatomy: her ovaries, her egg quantity and the uterus. Then, we schedule the other procedures: the blood work as appropriate and a test called a hysterosalpingogram, which in layman’s terms is the dye test. That tells us if the tubes are open and if the cavity of the uterus is normal. The husband just has to schedule a semen analysis.
When all of these tests are complete, the basic assessment is complete and we can discuss the results and make a treatment plan for the patient once we have the diagnosis.
What are the common causes of infertility?
Male factor infertility, where a man has issues with his sperm, is found in about 30 percent of cases. Around 15 percent will be mainly male factor where the abnormalities in the sperm are the principle reason why the couple is not getting pregnant.
Another biggie is tubal factor infertility. About a third of the time, a woman will have issues with her tubes, either blocked or damaged tubes that are causing infertility. Fifteen percent of the time it will be ovulatory dysfunction where she’s not ovulating properly. There can also sometimes be unusual factors. There can be endometriosis about 10-15 percent of the time, there can be congenital abnormalities and hormonal issues.
There are a variety of reasons why infertility can occur. But the most frustrating one is unexplained infertility where, in about 15 percent of couples, there is no problem. All testing is normal, yet they’re not getting pregnant. Of course, the question is, Why am I not getting pregnant, all my tests are normal?
The answer is, we don’t know. There are so many things that have to happen just right for a couple to get pregnant. There are some subtle things that we cannot test for. Obviously there’s something going on, we just don’t have a test for it.
The good news is that young women have excellent prognosis, we can use simple treatment strategies and still help them get pregnant.